2012-10-12T11:40:23-05:00 2011-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2011-01-01 416023462 MINNESOTA CEMENT MASONS HEALTH & WELFARE C/O ZENITH AMERICAN SOLUTIONS MINN 6512561804 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 GREGORY MASSEY 6512561804 2012-10-09 1 ERIC C BAERTSCH P00964071 9528413950 2011 2016-02-24 21:20:13Z GREGORY MASSEY 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 10185236 0 X N/A X 1960 MN TO PROVIDE HEALTH BENEFITS 8 7 7 0 0 0 0 0 7024636 7081031 320085 260760 0 22246 7344721 7364037 0 0 6078713 5883416 0 0 0 0 0 560154 687449 6638867 6570865 705854 793172 11059116 11800517 53698 55044 11005418 11745473 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS OR BENEFICIARIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 254 0 1 7 1 0 0 0 0 0 0 0 0 X 8 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561804 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 X GREG JOHNSON 2.00 X 0 0 0 GREG MASSEY 2.00 X 0 0 0 ARLAND ANDERSON 2.00 X 0 0 0 STEVE BULACH 2.00 X 0 0 0 ROBERT RIDGE 2.00 X 0 0 0 DAVE SCHUTTA 2.00 X 0 0 332 PAM GRAVES 2.00 X 0 0 0 MIKE SYVERSRUD 2.00 X 0 0 0 TIM WORKE 2.00 X 0 0 0 DAVID JOSLIN 2.00 X 0 0 0 JAMES TURITTO 2.00 X 0 0 0 0 0 332 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 THIRD PARTY ADMINISTRATOR 302185 1 EMPLOYER CONTRIB 900099 6390302 6390302 SELF-PAY CONTRIB 900099 690729 690729 7081031 241483 241483 2840476 2821199 19277 19277 19277 CATALYST RX REBATES 900099 22186 22186 ERRP REIMBURSEMENTS 900099 60 60 22246 7364037 7081031 0 283006 5883416 100926 13300 35620 461769 42880 13778 9015 GOVERNMENT COMPLIANCE 7826 DUES & SUBSCRIPTIONS 2335 6570865 438217 588028 3775587 4109203 413044 542301 10475 3065 6421793 6557920 11059116 11800517 53698 55044 53698 55044 X 0 0 0 0 11005418 11745473 11005418 11745473 11059116 11800517 X 793172 -53117 X 0 1 1 X 0 0 7364037 6570865 793172 -53117 -53117 740055 7275300 -53117 -53117 7328417 35620 35620 7364037 6535245 0 6535245 35620 35620 6570865 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE BOARD OF TRUSTEES RETAINS THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY ADMINISTRATIVE DUTIES TO ZENITH AMERICAN SOLUTIONS AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO, REVIEWED, AND APPROVED BY THE ENTIRE BOARD OF TRUSTEES BEFORE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES EVALUATE ANY POSSIBLE CONFLICTS OF INTEREST ANNUALLY WITH THE PLAN'S ATTORNEY. IN ADDITION, TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH NONPROFIT PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS LAWFUL STATUS AND FIDUCIARY OBLIGATIONS, PERIODIC REVIEWS OF COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ARE CONDUCTED. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -53117.